腰椎后是融合和BAK椎体间融合的疗效比较

目的 证明BAK椎体间融合优于后外侧融合。方法 腰椎滑脱26例采用Steffee钢板和后外侧融合与腰椎滑脱16例采用Silhouetle脊柱棒系统对腰椎滑脱复位固定和BAK椎间植骨融合器椎间植骨融合，比较它们的融合、复位和临床结果。结果 后外侧融合26例随诊6－36个月，临床融合率80.8%(21/26)，滑脱复位率61％（16／26），临床疗效：优9例，良9例，可3例，差5例，优良率69％。BAK椎体间融合16例患者随诊6－20个月。临床融合率为93.7%(15/16)，滑脱复位率为87.5%（14／16），临床疗效：优9例，良5例，可2例，优良率90％。结论 对腰椎滑脱的复位固定，Silhouetle脊柱棒系统较Steffee钢板有较多优点，与后外侧融合比较，BAK椎间融合器植入椎间隙后，椎体界面间固定，椎间隙无塌陷，无植骨吸收，能增大和维持椎间隙和椎间孔高度，间接扩大侧隐窝和恢复脊柱生理曲度，有较大的植骨床，有利于植骨融合，使患者早期下床。近期随访结果表明，Silhouetle脊柱棒系统固定和BAK椎间植骨融合器椎间植骨融合的临床疗效明显优于Steffee钢板固定和后外侧融合。     

Steffee钢板复位固定椎体间植骨治疗腰椎峡部裂

目的　探讨Steffee钢板复位固定 ,椎体间植骨融合治疗腰椎峡部裂的临床疗效及适应证。方法　 31例有严重腰痛和(或 )神经根症状的腰椎峡部裂患者 ,其中 2 2例合并有脊柱滑脱 ,采用Steffee钢板复位固定、游离“人”字形椎板植入椎体间植骨融合 ,观察复位情况、融合率、并发症等。结果　经随访所有病例均骨性融合。 2 2例并脊柱滑脱病例 ,完全复位 1 3例 ,部分复位 9例。疗效评价 :优 2 9例 ,良 2例。并发症 :术后脑脊液漏 1例 ,神经根牵拉伤 1例。结论　有严重腰痛和 (或 )神经根症状的腰椎峡部裂患者 ,可采用Steffee钢板复位固定、游离椎板椎体间植骨融合术治疗 ,其临床疗效满意     

Steffee钢板复位固定椎体间植骨治疗腰椎峡部裂

目的探讨Steffee钢板复位固定，椎体问植骨融合治疗腰椎峡部裂的临床疗效及适应证。方法31例有严重腰痛和(或)神经根症状的腰椎峡部裂患者，其中22例合并有脊柱滑脱，采用Steffee钢板复位固定、游离“人”字形椎板植入椎体间植骨融合，观察复位情况、融合率、并发症等。结果经随访所有病例均骨性融合。22例并脊柱滑脱病例，完全复位13例，部分复位9例。疗效评价：优29例，良2例。并发症：术后脑脊液漏1例，神经根牵拉伤1例。结论有严重腰痛和(或)神经根症状的腰椎峡部裂患者，可采用Steffee钢板复位固定、游离椎板椎体间植骨融合术治疗，其临床疗效满意。     

侧后方融合联合人工珊瑚椎间融合器治疗腰椎滑脱

目的　探讨侧后方融合联合人工珊瑚椎间融合器治疗腰椎滑脱的临床疗效。方法　 2 1例腰椎滑脱 ,其中L4滑脱Ⅰ°5例 ,Ⅱ°3例 ,L5滑脱Ⅰ°7例 ;Ⅱ°3例 ,L4、L5同时椎弓根不连滑脱Ⅰ°3例。平均年龄 4 8.5岁 ,采用后手术入路 ,用Steffee钢板提拉复位 ,侧后方融合联合人工珊瑚椎间融合器椎体间融合稳定脊柱。结果　随访 6～ 4 2个月 ,平均 19.1个月 ,19例术后腰痛消失 ,并感腰部稳定有力 ,18例恢复原工作与生活 ,其中有 5例术后 6个月后恢复体力劳动 ,摄腰椎正侧位片及过屈、过伸位片 ,见椎体间相对运动消失 ,椎间隙较术前平均增高 4mm ,椎间植骨已骨性模糊与上下椎体融合 ,未出现椎体再移位的并发症。结论　采用侧后方融合联合人工珊瑚椎间融合器椎体间融合吸收了前后路两种融合方法的优点 ,使融合率大大提高 ,增强了脊柱的稳定性 ,临床疗效满意。     

两种方式治疗腰椎滑脱症的疗效评价

应用Steffee钢板复位固定后外侧植骨融合、RF系统复位固定Cage椎间融合两种方法治疗腰椎峡部崩裂滑脱39例。本文进行回顾分析,对其在临床的应用作一对比评价。1临床资料1.1一般资料本组腰椎峡部崩裂滑脱39例,男14例,女25例,年龄28～67岁,平均45.6岁。单侧下肢放射痛23例,双侧下肢放射痛15例,跟腱反射减弱12例,拇背伸肌力减弱14例,小腿外侧皮肤感觉减弱35例,痛觉过敏5例,L4滑脱26例,L5滑脱13例。采用Steffee钢板复位固定,后外侧植骨融合16例,采用RF-Ⅱ系统复位固定Cage椎间融合23例。1.2手术方法1.2.1Steffee钢板复位固定、后外侧植骨融…     

GSS加椎间融合器治疗腰椎滑脱的临床分析

目的探讨后路应用通用型脊柱内固定系统（GSS）和椎体融合器（PEEK）经椎体间植骨融合术（PLIF）治疗腰椎滑脱的临床效果。方法对25例腰椎滑脱患者采用后路全椎板减压，GSS经椎弓根内固定并对滑脱椎体行复位固定，椎间融合器椎间植骨融合。结果随访12～36个月，临床优良率92.0%。12个月复查X线片均显示椎体间骨性融合。结论GSS椎弓根螺钉系统能有效撑开提拉滑脱椎体，复位满意，固定力强，并为彻底减压提供有效空间。采用椎间融合器植骨融合能有效提高植骨融合率。     

椎弓根系统复位珊瑚人工骨椎间融合治疗腰椎滑脱

[目的]观察椎弓根系统复位固定和珊瑚人工骨椎间融合的方法治疗腰椎滑脱的临床疗效。[方法]22例腰椎滑脱（Ⅰ度11例，Ⅱ度9例，Ⅲ度2例）经保守治疗无效的病人，平均年龄48．5岁，均行手术治疗，用Steffee钢板和RF-Ⅱ型椎弓根系统复位固定，珊瑚人工骨椎间融合加外侧后方植骨融合。[结果]随访12-54个月（平均23．6个月），优15例，良5例，中2例，优良率为90％，所有患者滑脱椎体得到融合。[结论]采用椎弓根复位固定系统和珊瑚人工骨椎间融合的方法治疗腰椎滑脱，临床疗效满意。     

椎间融合器联合后外侧植骨融合治疗腰椎滑脱症

目的探讨椎间融合器联合后外侧植骨融合治疗腰椎滑脱的术后效果。方法 2007-01-2011-01采用椎间植骨联合后外侧植骨融合治疗腰椎滑脱患者32例。结果随访12～38月,平均16个月,根据Suk方法判定术后骨融合情况,骨融合率为100%。根据邹德威等临床功能评价标准评分:优19例,良10例,可3例,优良率90.62%。结论椎间融合器联合后外侧植骨融合术治疗腰椎滑脱是一种较理想的手术方法,能维持脊柱稳定性,恢复椎间隙高度和提高植骨融合率。     

椎问隙狭窄型峡部裂性腰椎滑脱的手术治疗

目的探讨椎间隙狭窄型峡部裂性腰椎滑脱的手术方法及临床疗效。方法对30例椎间隙狭窄型峡部裂性腰椎滑脱患者采用钉棒系统内固定加经椎间孔椎体间融合器结合打压植骨融合（TLIF）术进行治疗。结果随访12—18个月,所有患者腰腿痛症状均消失,植骨融合率100％,4例患者残留部分下肢麻木症状。结论钉棒系统内固定加经椎间孔椎体间融合器结合打压植骨融合（TLIF）术可达到恢复椎间隙高度、神经根孔间接减压、椎管减压、重建脊柱的生理曲度和脊柱的稳定性的效果,是一种可靠、有效的方法。     

腰椎滑脱合并椎管狭窄的手术治疗

目的：分析比较不同手术和植骨融合方式对腰椎滑脱合并椎管狭窄的治疗效果。方法：对76例诊断为腰椎滑脱合并椎管狭窄进行彻底的椎管减压，采用三种方法内固定，U型棒23例，Steffee钢板20例，RF系统33例；二种方法植骨融合；两侧横突及关节突间植骨融合50例，后路椎体间Cage植骨26例。结果：随访6个月－10年，患临床症状缓解优良率为92．1％，对滑椎的复位率Steffee钢板和RF系统分别是90．0％和81．8％，U型棒则几乎起不到复位作用，二种椎间植骨融合率分别为94．0％和96．2％，结论：腰椎滑脱合并椎管狭窄手术治疗时应彻底椎管减压，椎弓根螺钉系统能可靠地将滑椎复位，复位后应根据病人的具体情况选择适当的椎体间植骨融合。     

钛钢螺纹椎体融合器（TFC）在脊柱疾病中的应用研究

报告钛钢螺纹椎体融合器（ｔｈｒｅａｄｅｄｆｕｓｉｏｎｃａｇｅＴＦＣ）在４１例脊柱疾病中的应用情况。随访１０～３６个月，平均２４个月，症状无复发，融合器无移位，无植骨吸收和假关节形成，取得满意效果。分析了这种固定融合的生物力学特性，并与椎弓根钢板结构、单纯植骨融合的脊柱生物力学特性进行比较，优于后两者。此种固定融合技术的特点是：椎体界面间固定，能增大和维持椎间隙和椎间孔高度，有利于植骨融合，利于患者早期下床活动。提出在脊柱疾病中的应用范围，如颈椎不稳定、腰椎不稳定、退行性椎间盘病变、腰神经根管狭窄、颈椎病、腰椎滑移、腰椎间盘术后复发等疾病。认为ＴＦＣ融合技术是一种较好的椎间固定融合技术，值得进一步推广。     

Fusion correction of polydactyly

Polydactyly is the most common aesthetic hand anomaly. Its surgical correction is indicated for aesthetic, but especially for functional reasons. Independent of the degree and location (pre- or postaxial) of the anomaly the creation of one single unit, which corresponds to the functional as well as to the cosmetical demands is the main purpose of the operative correction. The principle of this operative procedure is the fusion of the two fingers by using all existent structures. Therefore and due to the individuality of each case of polydactyly only after clear exposure identification of soft tissue structures is possible. Resecting procedures of bony and soft tissue structures which are performed before the fusion shall therefore be performed after the exposure and by preservation of all structures, which are necessary for growth, function, sensibility and blood supply. Using these principles clinical experiences which were made with this method are demonstrated while also postoperative results are shown.     

Pediatric Hip Fusion

The management of young patients with severe hip arthritis is very difficult, as treatment options, such as total hip arthroplasty, which is excellent for relieving pain while preserving function, are often avoided because of a high requirement for subsequent revision surgeries. Hip arthrodesis, although perceived as having inferior functional outcomes in these young individuals, offers a treatment option that relieves pain, maintains function, and allows for conversion to a total hip arthroplasty in future, if desired. This article reviews the indications and technique of hip fusion.     

The Importance of Proximal Fusion Level Selection for Outcomes of Multi-Level Lumbar Posterolateral Fusion

BackgroundThere are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes.MethodsWe retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either ''good'' or ''bad'' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors.ResultsTwenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203).ConclusionsThe overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.